Carpal Tunnel Syndrome (CTS) is a fairly common condition affecting 1 out of 20 Americans, due to the demands that individuals place on their hands and wrists. It is caused by pressure on the nerve at the base of the palm (median nerve). Fortunately, Physical Therapy can often relieve pain and numbness/tingling and restore normal use of the hand, wrist, and arm without the need for surgery.
WHAT EXACTLY IS CARPAL TUNNEL SYNDROME (CTS)?
The carpal tunnel is a narrow passage on the palm side of your wrist, and is about the width of your thumb. This tunnel serves as protection for the tendons that bend your fingers as well as the median nerve. Any increased pressure on this median nerve can lead to pain and weakness in your wrist and hand as well as numbness/tingling in some of your fingers. Extreme wrist positions coupled with lots of finger use (especially w/lots of force or vibration such as gripping the steering while while operating heavy machinery) can all contribute to CTS.
CTS is very common in professions requiring the use of hand tools, especially tools that vibrate, as well as in assembly line work such as Amazon or UPS. Although we often think of computer work and excessive typing being most associated with CTS, in actuality assembly line workers are 3 times more likely to develop CTS than those who perform data entry work. Even some leisure activities such as sewing and playing stringed instruments such as the violin, as well as recreational sports such as handball and racquetball, can lead to increased risk of CTS. The following health conditions can also lead to CTS in certain individuals:
- Injuries to the wrist/hand (sprain/strain, fracture, dislocation)
- Inflammation/swelling of the tendons of the wrist
- Fluid retention (eg, during pregnancy)
- Hormonal or metabolic changes (eg, pregnancy, menopause, thyroid imbalance)
- Degenerative and rheumatoid arthritis
- Certain medicine use (e.g., steroids)
WHAT DOES CTS FEEL LIKE?
CTS often starts gradually with symptoms that can include numbness, tingling, “pins and needles,” or burning in the palm of the hand and fingers. In many cases the symptoms are more noticeable at night which often disrupts sleep. Many individuals try to “shake out” their hands in an attempt to try and relieve their symptoms. As the condition progresses and worsens, symptoms are experienced during the daytime and are often made worse by holding items such as a hairbrush or a heavy book. In time, you may find that you’re starting to drop objects unexpectedly or have a weakness in your grip. Things such as lifting a pot off of the stove, turning a key, or opening a jar can now become extremely painful or difficult.
HOW IS CTS DIAGNOSED?
Physical Therapists are specialists in the musculoskeletal system and experts in the movement and function of the body. They should conduct an extensive evaluation to determine all of the factors that may be contributing to your condition. The examination may include any/all of the following:
- A thorough evaluation of your neck and upper extremity to rule out other conditions. Many individuals have been informed that they have CTS only to find out through extensive screening that the symptoms are being caused by another area of the body.
- Range of motion of the hand/wrist
- Sensory tests
- Grip strength of hand, fingers, and thumb
- Prolonged wrist flexion (Phalen’s test)–Your Physical Therapist will instruct you to push the back of your wrist’s together for 1 minute. Numbness or tingling in your fingers that occurs within 60 seconds may be an indication of CTS.
- Tinel’s sign--Your Physical Therapist will use a reflex hammer or finger to tap over the median nerve at the wrist. Tingling in the thumb/index/middle fingers may indicate CTS
- Electrical studies–EMG, (or electromyogram), and NCV (or Nerve Conduction Velocity) may be indicated to determine the transmission of the median nerve and the severity of the CTS.
- X-rays–If trauma has occurred, or if there is a reason to suspect anatomical abnormality, X-rays may be indicated.
HOW CAN PHYSICAL THERAPY HELP?
If your Physical Therapy evaluation confirms early-onset CTS, then conservative care should be recommended as a first step. Physical Therapy treatment can be extremely effective in relieving your symptoms and getting you back to performing your normal activities. Depending on the causes of your CTS, your Physical Therapy program may include:
- Use of heat/cold treatments to relieve pain and inflammation
- Stretching exercises to improve the flexibility of the wrist, hand, and fingers
- Strengthening exercises for your forearm, wrist, hand, and fingers (and in some cases, postural muscles as well)
- Use of a night splint to reduce discomfort
- Education regarding:
- Changing wrist positions (i.e., avoiding prolonged bent wrist positions)
- Proper posture of the neck and upper back (i.e., avoiding forward head/rounded shoulders/slouched position)
- “Stretch breaks” during your work or daily routines
- Safe use of sharp utensils/tools/other implements, especially if sensory changes are identified
- Increasing the size of utensil and tool handles by adding extra material for a more comfortable grip
- Anti-vibration gloves (or anti-vibration wraps around tool handles) if vibration is a factor at your workplace
- Worksite/ergonomic assessment (eg, making sure computer monitor and keyboard are positioned properly, armrests of chair are proper height, etc.)
Since the goals of Physical Therapy are to relieve your symptoms and avoid surgery, enable you to be as active and functional as possible, and to help you to resume your normal work, home, and recreational activities, your Physical Therapist may also recommend that you wear gloves to keep your wrists/hands warm as well as limiting sports that aggravate your condition, such as racquet sports, until your symptoms resolve.
WHAT IF I NEED SURGERY?
In the event that symptoms were not caught in time and are too severe for Physical Therapy, then surgery may be indicated. If this is the case, the surgeon will release the band of tissue causing pressure on the median nerve. Physical Therapy is extremely important after surgery to help regain strength and mobility in the wrist and to assist you in modifying habits that may have led to your symptoms in the first place. Physical Therapy treatment post surgery may include:
- Scar management to keep the skin flexible
- Stretching to improve mobility of the wrist and fingers, as well as improve function
- Strengthening exercises to increase strength of the forearm/wrist/hand muscles
- Education regarding proper posture and wrist position to avoid compressing the carpal tunnel during home and leisure activities
- A worksite/ergonomic assessment to optimize postures and positions
CAN CTS BE PREVENTED?
Unfortunately, there are no proven strategies for preventing CTS, but Physical Therapy can help to minimize stress to your hands and wrists. Since there are any number of contributing factors to developing CTS, one single solution may not be effective. Here are some effective strategies for helping to minimize stress to your hands and wrists:
- Take frequent breaks–Give your hands a break once in a while by performing stretching exercises if doing repetitive activities
- Improve your posture–Believe it or not, proper alignment of your neck, shoulders, and trunk can prevent excessive strain and improper positioning of the wrists and hands
- Neutral wrist position–Try to keep your wrists in a straight (neutral) position and avoid bending your wrists excessively up or down
- Reduce force–Relax your grip to prevent muscle strain and fatigue. Many individuals use more force than needed when working with their hands. For prolonged handwriting, for example, use a larger handle pen or soft gel grip
- Work station modification–Simply having a Physical Therapist examine your work area and make simple adjustments based on things like your height, posture, and tasks required can make a huge difference in avoiding unnecessary strain
- Keep your hands warm–If you work in a cold environment you are more likely to develop hand pain and stiffness. Be sure to wear gloves to keep your hands and wrists warm if you can’t control the temperature.
- Maintain good health–Maintaining a healthy weight and staying physically fit may help to control diseases and conditions that may contribute to the onset of CTS. Paying attention to your general health is an extremely important step in preventing CTS.
If you or someone you know has symptoms related to CTS don’t wait to take action. Call my office at once at (302)691-9055 or go to my website at www.wildermanpt.com to schedule your FREE 30 minute consultation to see how Physical Therapy can help. Don’t delay–schedule now!